Omalizumab确保蜂毒免疫疗法(VIT)的兼容性后,viti诱导过敏反应的系统性肥大细胞增多症患者。

Allergologie Select Pub Date : 2021-03-11 eCollection Date: 2021-01-01 DOI:10.5414/ALX02196E
Askin Gülsen, Franziska Ruëff, Uta Jappe
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引用次数: 12

摘要

背景:膜翅目毒液引起的全身反应和过敏反应在欧洲人口中发生率高达7.5%。致命的刺痛反应非常罕见。所有有严重反应史的患者都应检测血清胰酶水平,以检测肥大细胞增多症,并确定对毒液免疫治疗(VIT)产生严重反应的风险。在肥大细胞增多症患者中,由于昆虫叮咬而发生严重甚至致命的过敏反应的风险相当高。因此,在这些高度危险的患者中,建议终身进行VIT。涉及大量人群的多中心研究报告称,高达20%的VIT患者对免疫治疗有不耐受和全身反应。其中一些副作用反复发生,不能通过标准治疗来控制。在许多情况下,用抗ige抗体omalizumab进行预处理是有用的。然而,omalizumab未被批准用于适应症过敏反应。因此,目前对于omalizumab的预处理仍没有明确的方案,最佳持续时间、剂量以及长期获益仍不清楚。病例报告:我们提出了一个60岁的女性患者肥大细胞增多症谁发展了严重的过敏反应,在蜜蜂VIT开始。血清胰蛋白酶升高,随后证实KIT突变D816V。成分分辨诊断试验显示仅针对重组Api m1的特异性IgE抗体。患者接受150mg omalizumab治疗,在重新开始免疫治疗前5周、3周和1周皮下给药,并与VIT并行治疗2个月。增加剂量是在7天内完成的。在此期间,没有发生过敏反应,并且蜜蜂对VIT的耐受性良好,高达200µg蜂毒。该患者目前处于治疗的第三年,对治疗的耐受性非常好。结论:Omalizumab可作为不耐受VIT的肥大细胞增多症患者的前用药。虽然对治疗方案没有共识,但2 - 6个月的治疗被认为是足够的。这种治疗的长期效益需要进一步研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Omalizumab ensures compatibility to bee venom immunotherapy (VIT) after VIT-induced anaphylaxis in a patient with systemic mastocytosis.

Background: Systemic reactions and anaphylaxis due to Hymenoptera venoms occur in up to 7.5% of the European population. Fatal sting reactions are very rare. Serum tryptase levels should be measured in all patients with a history of severe reactions in order to detect mastocytosis and to determine the risk of severe reactions to venom immunotherapy (VIT). The risk to experience severe or even fatal anaphylaxis due to insect stings is quite high in patients with mastocytosis. Therefore, lifelong VIT is recommended in these highly threatened patients. Multicenter studies involving a large population report that up to 20% of patients undergoing VIT have intolerance and systemic reactions to immunotherapy. Some of these side effects occur repeatedly and cannot be managed by standard treatment. A pre-treatment with the anti-IgE antibody omalizumab was useful in many cases. However, omalizumab is not approved for the indication anaphylaxis. Therefore, there is still no defined protocol for omalizumab pre-treatment, and the optimal duration, dosage as well as long-time benefits are still unclear.

Case report: We present a 60-year-old female patient with mastocytosis who developed a severe anaphylactic reaction during initiation of bee VIT. Serum tryptase was elevated, and a KIT mutation D816V was subsequently confirmed. Component-resolved diagnostic tests revealed specific IgE antibodies to recombinant Api m 1 only. The patient was treated with 150 mg omalizumab, administered subcutaneously 5 weeks, 3 weeks, and 1 week prior to re-start of immunotherapy and for 2 months in parallel to VIT. Updosing was done by a 7-day rush schedule. During this period, no anaphylactic reaction developed, and the bee VIT was well tolerated with up to 200 µg bee venom. The patient is currently in the 3rd year of treatment and tolerates the treatment very well.

Conclusion: Omalizumab may be used as a premedication in patients with mastocytosis who do not tolerate VIT. Although there is no consensus on the treatment protocol, treatment for 2 - 6 months is considered adequate. The long-term benefits of such treatment require further research.

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